SEPTEMBER 2009 – NO. 35
The Anatomy Lesson
A med school rite of passage that shows who we really are inside
On the first day of class, I am mistaken for a teaching assistant six times, which, on the one hand, simply tells me I'm old — a good 20 years older than the average student — but, on the other hand, seems to imply that I look as if I belong. Choosing the glass half full, I smile through each mistaken identity.
The class size is 120 (150 if you count the cadavers). We had been warned beforehand that some students are overwhelmed by the first sight of the dead bodies. And sure enough, some students clearly are. But I am more freaked out by the woman in the gas mask. What does she know that the rest of us don't?
"Class? Hello?" comes a disembodied voice, tinnily amplified. This is Sexton Sutherland, one of the three professors for this ten-week course in gross anatomy at UCSF, although I cannot see him for the crowd. "Before we get started, some housekeeping rules: No eating your lunch in here." This elicits a collective ewwwww. "No music. Please don't take any pictures. And try to keep your voices down. Laughter's okay," Dr. Sutherland adds, "it's a great way to release emotions. But not at the expense of the wonderful people who've donated their bodies to our program." He lets that sink in for a moment. "Okay, let's get going."
Six of us arrange ourselves around cadaver number four, but, rather than looking at the naked female body lying before us, we all stare at one another.
"I haven't dissected anything since high school biology," one of the three women admits, breaking the ice. "And that was a frog."
This seems like the right moment to make an admission of my own: "I should tell you, I am not a student here." I explain that I'm doing research for a book on Henry Gray and Henry Carter, the anatomists who created the 19th-century classic Gray's Anatomy, and I've gotten permission to attend their lectures and labs. "I'm just going to be an observer."
All but one of them look as though they would pay to change places with me. Gergen, the exception, a tall, husky, hairy guy who says he has never dissected anything in his life, cheerfully volunteers to begin the dissection.
Our cadaver was partially dissected during a previous course, so the first task is simply to "unpack" the earlier work. Gergen folds back the two panels of skin incised atop the chest, then grasps the edges of the underlying breastplate, a solid shield of ribs and muscles that had been precut with a surgical saw. He lifts, and a powerful wave of fumes escapes from the cadaver, making all of us flinch.
Gergen, now greenish, appears on the verge of losing his cool and, perhaps, his lunch, so Amy agrees to take over. I read aloud from the lab guide as she picks up a scalpel and makes a large, neat cross-shaped cut atop the pericardium, the opaque protective sac that encloses the heart. She peels back each flap, exposing the heart, then reaches for a larger blade. Amy looks so comfortable using a scalpel that I cannot resist asking if she's ever thought about becoming a surgeon.
"Not until now," she answers with a smile.
Amy slices through the blood vessels entering and exiting the heart, puts down the knife, grasps the heart with both hands, and tugs, uprooting the organ from its bedding in the chest. Switching to a fine blade, she makes a small doorway into the right atrium and a larger opening in the left ventricle.
One of the other instructors, Dana Rohde, has been observing how we are doing, and she suggests that someone take the heart to the sink and rinse it out.
With an air of quiet ceremony, Amy places the heart into my gloved hands, and I instinctively draw it to my chest. My own heart instantly speeds up. The lab suddenly seems terribly crowded, the distance to the big stainless steel sink vast. I feel as if I were carrying the most fragile thing in the world, which is silly, for our heart is already broken in a sense; our cadaver had died of heart failure.
Once I begin rinsing the heart, cradling it with one hand while rubbing it with the other, I relax. It is tough and rubbery. The aorta, the major artery emerging from the heart, is a severed garden hose, and the smaller blood vessels — once thought to be heartstrings that keep the heart in place and can be tugged or plucked to elicit different emotions — are like the roots of a turnip. What washes down the drain is a grainy brown paste, coagulated blood. I pat the heart dry and return to our table.
You cannot hold a human heart without questioning how it ever became known as the center of emotion or, as the sixteenth century French surgeon Ambroise Paré once grandly described it, "the chief mansion of the Soul, the organ of the vital faculty, the fountain of the vital spirits." To me, the heart does not look or feel like anything but what it is, a tough, muscular pump. But wait, not so fast.
"Let me show you something," Dr. Rohde says before moving on to the next group and the next body. We crowd around her as she lifts up our heart and pulls the doorway into the right atrium as far back as it will go.
"Now, unfortunately, you can't actually see it," Dr. Rohde says, "but, right inside here, where the superior vena cava enters the right atrium" — she points to a spot at the top of the fold — "right at that ridge is a little area where a cluster of cells is embedded. It's called the sinoatrial or S-A node, but it's known as the pacemaker. In other words, this is where your heart's speed is set."
While she explains how the S-A node works — electrical signals generated by these cells spread to other cells across the heart, causing it to contract, to beat — I find myself dazzled by this perfect meeting of anatomy and metaphor. In the human body, the node is positioned right under the sternum, dead center in the chest. So, in a sense, this truly is where feelings such as terror, love, and elation are first felt — where your heart starts to race, pound, flutter.
Looking up, I notice that Amy is doing exactly what I am doing: we both stand with a hand at the center of our chests, instinctively feeling the moment. Here, right here, is where wonder begins.
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